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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT X30 q .............................................��.'�' Permit No. ..7 ..T (Complete in Triplicate) ......................•--•_- This Permit Expires ] Year From Date Issued Date Issued .. ��T z7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is,made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB AQQRES5/LOC�iTiON ................. . . .." ?.._. ....:_ Q_:Y! 1. .....-..._. .................CENSUS TRACT ..................... Owner's Name .a'1.�-- ------. --•--..................•.....................................••-._.................._..Phone ...........................I........ r _.� a?.k�.t S ity Address .... .4........: C' ---•---------- -•............................................ . ......... Contractor's Name V,0*0..... s� l...... Pn_�.. ..........................License # -°�-_�_.147-;3J.. Phone,..q. ............. Y+1... Installation will serve: ,ResidenceApartment House o Commercial '❑Trailer Court i❑ ..5r Motel ❑Other ........................... ------_----_- �i Number of living-units:._--_�__::-:.Number-of bedrooms .�_-•-Garbage Grinder �/JA?Z... Lot Size,/...a� ... .�t�., ......_... =•---------------•-----......._.......Private Water Supply: Public System and name --------------------------------------------•............................- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy Peat[]`"'Sondy Loam .C] Clay Loam p Hardpan ❑ Adobe ill Material ... If yes,type ...I------------------------ (Plot p)an, showing size of lot, location of system in relation wwells, buildings; 'etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer I's available within 240 feet,) PACKAGE TREATMENT [ J SEPTIC TANK J : ' A Size........................w...4 Liquid Depth .......................... . Capacity -------------••--•-• Type ..................... Moterial.'-•-" ' No. Compartments ...................... Distance to nearest: Well "....... ..................._'__Foundaf-0n ...._ ................ Prop. Line ..........._.......... ,_,_.. r LEACHING LINE RLI No. of Lines ......... .............. Length of each line.----------................. Total Length �- 'D' Box ............ Type Filter Material ,...........:._:Depth, Filter Material ........................................:... Distance to.nearest: Well .-'................... Foundation Property Line ......................... :SEEPAGE PIT .bepth .................... Diameter .................. Number ....---------............... hock Filled Yes ❑ No {:]0 • ! Water Table Depth stock Size Distance to nearest- Well .. -....... p• x • -•--------------- ------ ......Foundation -•--••--••---•---•-• Pro tine ...................... REPAIR/ADDITION(Prev. Sanitation Permit#,....:............... U' ----------------------- Date ----•---...._...._..-----•--.... .) Septic Tank (Specify Requirements) . •............. ...... -- -.......�I--- --------- Disposal Field (Specify Requirements •--.-----.:- -. .......,... ...... ... .. .. ._ ...................................... --------------------- ----------------------------------------------- ................................................ .............................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------- ------ --- -------- Owner X B -----•-----•-•--------- By it e (if oth t n owner) I FOR DEPARTMENT USE ONLY ti_ APPLICATIONACCEPTED BY --•• •. --•- -- ...... .................................................... DATE ...-7 . ••- ._.. ---------... BUILDING PERMIT ISSUED ....... . .. ... .... DATE ........ ADDITIONAL COMMENTS ...... ----01 -.---.._......._ -------------------• --------------._................................................................................ .............................................. . Final Inspection by. ............................................................................ Date .... *..... SAN JOAQUIN LOCAL HEALTH DISTRICT -